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Health Reform – Cover More People By Containing Cost

Here’s a very brief quiz about the newest healthcare reform battle about to be waged:

Question:  What do you get when we add more uninsured people to an already costly and inefficient system?

Answer: A MORE costly and inefficient system!

This quiz was not meant to be humorous, nor is it. But if you think we are upset with our healthcare costs today, just wait for what may come next.

As in 2009-2010, similar contentious debates are being made on how to expand and pay for American’s health coverage. We now live in a never-ending polarized environment. Every day we learn about another new plan to rewrite what health insurance should look like in this country. Policy wonks are kept perpetually employed through this process – a really nice form of job security.

So, will we ever see breakthrough policy changes covering more Americans (beyond Obamacare) that will enhance our health (and productivity) at a more affordable cost? Without any doubt, it depends on the political will of both parties. Unfortunately, in the healthcare arena, good policy may not be good politics. In other words, what is best for addressing the core issues and problems of healthcare may not be best for sustaining a political career during the next election cycle. 

If we stay fixated on tying one-fifth of our economy to two-to-four-year election whims, we are doomed to repeat the cycle of not adequately addressing the core problems in our healthcare ‘system,’ which is, primarily, controlling costs. The premise of Obamacare was more about focusing on access first, while neglecting to address cost. 

By the end of 2017, our country is projected to spend about $3.7 trillion in healthcare, which will be 15 percent higher than what we spent in 2015 ($3.2 trillion). To put this into greater perspective, what our country spent on healthcare in 2015 exceeded the gross domestic products of all but four nations. Ironically, so much political capital is exhausted on three essential questions that do not address the root causes of cost:

  1. Who should be covered?
  2. Who should pay for this coverage?
  3. How much should they pay for this coverage?

Many agree that it is good policy to cover more Americans, which will have a positive impact on achieving a healthier population – regardless of demographic differences (age, race, income, location, etc.).

But, as we continue dividing a ‘bloated’ pie laden with sizeable waste between public and private payers, and provoking enraged differences between political parties and citizens, it will be equally logical to address the fundamental causes that make this pie bloated in the first place. 

‘Replacing’ or ‘reforming’ portions of Obamacare should also come with a clear political consensus on eliminating waste and developing performance measures that will provide sufficient feedback on just how well our bloated system is progressing (or not) when providing that care. On a per capita basis, America is already paying a grossly higher amount for healthcare when compared to all other industrialized countries in the world – and some of these countries have universal coverage for their population. One can quite successfully argue that our country has enough money in the current system to cover the entire population. What we lack is the political will to find prudent ways to reapportion our limited financial resources so that it is strategically used more efficiently to also address the social determinants of health. Policymakers are lobbied hard by key industry stakeholders who stand to lose their slice of the bloated ‘entitlement’ pie.

The upcoming debate should begin on what is universally agreeable, but unfortunately, most often ignored. The care provided in this country is woefully underperforming when compared to the cost of this care. This is primarily due to little transparency on price and care outcomes. ‘Value-based care’ – an often over-used phrase – begins with complete transparency in what we pay and receive.

Think about it.  If you or a family member has surgery in a hospital, do you really know the true cost BEFORE the elective surgery takes place? I’m not talking about ‘estimated’ cost, but rather, ‘actual’ cost. (One primary example of how surgery prices can be transparent is found at Surgery Center of Oklahoma.) Then, perhaps three-to-six months following surgery, are you queried by that hospital (or their agent) about how you or a family member is doing after that surgery?  This information is so vital to collect because it will eventually allow for future healthcare delivery improvements.

Who tracks medical outcomes?

Who tracks our medical outcomes on a national, regional or state level? By logic, you may be led to believe that this is being handled. But, despite the great activity seemingly generated by providers and their paid agents, this simply is not happening in most places. For example, the CMS Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is sent to a random sample of adult patients in the period of forty-eight hours to six weeks following discharge, but this patient-reported experience addresses hospital performance measures while the patient was in the hospital, not the outcomes experienced by the patient sometime later. The national experiment of paying hospitals to coax better outcomes has been a mixed-bag to date. According to national experts, Hospital Value-Based Purchasing (VSP) have been discouraging.

Transparency will sometimes be mentioned during reform – but tragically, it somehow becomes a casualty during the political process. The inconvenient truth is that full transparency in pricing and medical outcomes may not be in the best interest of many healthcare organizations because obfuscation is still considered to be a ‘competitive advantage.’ In healthcare, the product should not be the PRICING of the care, but rather, the CARE itself. When policy is being made, lobbying participants will usually find a seat at the table, nudging out the much larger but generally diffused public. Any public transparency initiatives soon morph to opaqueness. The key, therefore, is to have good policy also become good politics.

No doubt, some progress is being made in the delivery and payment of healthcare, but much work remains.

Perhaps Yogi Berra phrased it best: “It’s like déjà vu all over again.”

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Chasing Squirrels – the GOP’s Pursuit of Obamacare

As happens almost daily, when I take our family Shih Tzu-Poodle for a walk, he will invariably spot a lone squirrel near the driveway foraging for food in the front yard. Acting on pure instinct, Oreo will initiate a chase, presumably to catch the squirrel before it ascends to a nearby tree. Recently, Oreo surprised a ‘lazy’ squirrel and was within three yards of catching it, but the wily squirrel was able to outrace the jaws of our 20-lb house pet.

By watching this somewhat comical incident, I mused to my wife, “Assuming Oreo caught the squirrel, what would he actually do with it?” We both concluded that this particular pet would “have no clue” on how to proceed. For Oreo and most canines, chasing squirrels is essentially a ‘sport’ that requires little forethought about what may follow should the improbable event happen.

Following the November election results, we are bombarded daily with news about the fate of Obamacare. Since 2010, when the Affordable Care Act (aka, Obamacare) was created, Republicans have battered Democrats with generic claims that this legislation is directly responsible for rising premiums and frustrations within our country. Frankly, there are mixed truths to these claims. We can all agree, healthcare delivery and payment problems preceded this mammoth law, and many of these problems (e.g. overpriced and opaque healthcare) persist to this day.

In a different way, Obamacare has become the GOP’s ‘squirrel.’

I am often asked the question: “With Republicans taking control of both houses of Congress and the White House, how will ‘repeal and replace’ campaign promises play out?” Unfortunately, I don’t have an answer. Then again, nobody does – not even Republicans. Intra-party diversity on healthcare ideology is the only sure thing we know as 2017 begins. Even the savviest of policy wonks have nebulous notions about how to proceed with ‘fixing the atrocities’ of a major partisan law that has had almost seven full years to ‘bake’ within our health ‘system.’

This much is known. After the January 20 inauguration, the GOP will have the ability to begin dismantling Obamacare. Portions of this law, if related to federal revenues and spending, will require only a simple majority (51 votes) in the Senate for repealing – Republicans have 52 Senate votes in the new Congress. However, parts of the law not directly related to federal spending, such as insurance market reforms, require at least 60 votes to overcome a Democratic filibuster in the Senate – most likely resulting in a messy and prolonged process.

Suffice it to say, there are a myriad of routes that “repeal and replace” measures can take, with most all scenarios requiring a transitional period for replacement plans to buffer against coverage disruption. Yet again, one-fifth of our economy will be profoundly impacted by how the ‘other’ party will treat the captive squirrel.

Unless bipartisan support suddenly becomes ‘in vogue,’ any new legislation to replace Obamacare will consequently become a big target on the back of Republicans – a role reversal for both parties. The GOP will own their new creation and subsequently become the ‘hunted,’ an unenviable position to have in future elections.

The times they are a changin’. Maybe sometime soon, the squirrels will be chasing Oreo!

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Volunteering = Positive Health Outcomes

The resolutions we make to change undesired personal traits or behaviors usually begin at the dawn of the new calendar year – an attempt to ‘start over’ and refresh our hopes and desires to make us more productive, perhaps improve our health (and appearance), and move us to a happier state.

Perhaps you have joined a fitness club, initiated a new dietary program, developed a budget to save more and spend less, or carved out more time to read rather than watch television shows. There are a host of other new beginnings that may meet your personal goals.

So, after just a few days into 2017, how are you doing?

Have you thought about volunteering your time within your community to benefit another person, group or organization? Perhaps serve on a committee at your church, spend time assisting an individual to shop for groceries or attend a doctor or dentist appointment, or participate with a non-profit organization to take care of our underserved vulnerable populations (e.g. homeless, disabled, elderly, etc). This isn’t necessarily about altruism, though having an unselfish regard for helping others is certainly important and admirable for the health of any community.

Volunteering actually invites a new sense of purpose to our lives that consequently impacts our OWN mental well-being. Sounds somewhat self-serving doesn’t it? But promulgating our own well-being by volunteering our time and resources to help others actually makes a great deal of sense. Such activities positively impact the social determinants of health for our communities.

Recent studies indicate a positive relationship between volunteering and healthy outcomes, such as  self-rated health, and risk factors for cardiovascular disease, disability, mental well-being and life satisfaction. Some studies report that volunteering activities can reduce the risk of mortality. A person who volunteers will have a larger social network of connections and a personal sense of accomplishment that comes from helping others.

Listen up to those age 40-plus

A 2016 study in The BMJ suggests that there is “no clear evidence that volunteering was positively associated with mental health during early adulthood to mid-adulthood.” However, a positive association with mental health became more apparent after around 40 years of age and “continued up to old age.” This same study reveals that even for those of us who participate minimally in volunteering activities appear to have better mental well-being compared to those who don’t volunteer at all. Those who never volunteered had “lower levels of mental well-being starting around midlife and continuing in old age compared to those involved in volunteering.”

As with any life-changing resolution we embark in this new year, taking small, incremental steps to achieve our personal objectives is often underestimated. Yes, making massive changes sounds great for many of us, but this can also cause most of us to give up before we ever start.

It’s never too late to amend your 2017 resolutions. Volunteering your time will have a positive impact on your neighbors, community – and yes, even your own health!

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